Loss and change in primary care: Working with organisational anxiety

This paper will consider the identity of an inner voice that is experienced by everyone, but in very different ways. However, when working in the transference with psychotic patients the boundaries of personal identity and the question of choice and volition are so compromised by the illness that the phenomena are so to speak ‘writ large’. This allows the issues to be brought out with great vividness and intensity and it is the struggle with this that has led me to reconsider the identity of the inner voice in a way which I have found useful for the rest of my clinical work.

Prior to 1985, my clinical work with patients with psychotic illnesses was undertaken in the in-patient psychotherapy ward at Shenley Hospital that I was responsible for. With the movement of psychotherapy resources out of Shenley to set up the Willesden Centre, our ability to continue with this work was very compromised because the Centre is entirely an out-patient resource. However, a number of us persevered and gradually worked out ways to be able to continue to offer treatment to patients who had psychotic illnesses. This involved the establishment of a case-manager system to enable the therapist to work in the transference. This evolution has occurred in a specialist workshop that I have been running at the Willesden Centre since 1986.     

The Beliefs in the Inheritance of Risk Factors for Suicide Scale (BIRFSS): Cross‐Cultural Validation in Estonia,Malaysia, Romania,the United Kingdom,and the United States

The genetics of suicide is increasingly recognized and relevant for mental health literacy, but actual beliefs may lag behind current knowledge. We examined such beliefs in student samples (total N = 686) from Estonia, Malaysia, Romania, the United Kingdom, and the United States with the Beliefs in the Inheritance of Risk Factors for Suicide Scale. Cultural effects were small, those of key demographics nil. Several facets of construct validity were demonstrated. Marked differences in perceived plausibility of evidence about the genetics of suicide according to research design, observed in all samples, may be of general interest for investigating lay theories of abnormal behavior and communicating behavioral and psychiatric genetic research findings.     

The Epidemiology of Homicide followed by Suicide: A Systematic and Quantitative Review

This systematic review of population based studies of homicide followed by suicide was conducted to examine the associations between rates of homicide‐suicide, rates of other homicides and rates of suicide. The review analysed 64 samples, including the case of an outlier (Greenland) that were reported in 49 studies. There was a significant association between the rates of homicide‐suicide and those of other homicides in studies from the U.S.A. Outside the U.S.A. there was no clear association between homicide‐suicide and other homicide but there was modest but significant association between rates of suicide and homicide‐suicide. Homicide‐suicide appears to be closer in epidemiological terms to homicide than suicide in regions with high rates of homicide and measures to reduce homicide in these regions may also reduce homicide‐suicide.     

Matching therapeutic interventions to drug and alcohol abusers’ stage of motivation: The clients’ perspective

The present study aims to explore the issue of matching the appropriate therapeutic intervention according to the stage of readiness for change in addictive clients, following the model proposed by Prochaska and DiClemente in the 1980s. The study focuses solely on the perspectives of people with drug and alcohol problems, in contrast to previous ones which have been concerned with the researchers’ understandings and postulations of the issue under exploration. One of the most important findings of this study is that participants in the “early” stages of their readiness to change their addictive behaviour, irrespective of their gender or whether they had seen a therapist significantly prefer non-action-oriented therapeutic interventions than action-oriented interventions. Similarly, participants in the “later” stages, showed a significant preference to action-oriented than non-action interventions, irrespective of their gender or previous experience of counselling. It is suggested then that careful assessment of the stage of motivation and individual-tailored intervention should be an essential element of any treatment program for drug and alcohol addicted clients.     

A Systematic Review of the Relationship Between Rumination and Suicidality

Rumination has been persistently implicated in the etiology of hopelessness and depression, which are proximal predictors of suicidality. As a result, researchers have started to examine the role of rumination in suicidality. This systematic review provides a concise synopsis of the current progress in examining the relationship between rumination and suicidality, and highlights areas for future research. A search of the international literature was conducted using the three main psychological and medical databases. Eleven studies were identified providing evidence, with one exception, of a relationship between rumination and suicidality. This review also highlights the considerable dearth of studies on this area of concern, specifically of case‐control and prospective, clinical studies, in the worldwide literature.     

Evaluation of a School-Based Social Skills Program for Children With Attention-Deficit/Hyperactivity Disorder

Attention-Deficit/Hyperactivity Disorder (ADHD) is prevalent among school-aged children. An associated feature of the disorder is a deficit in social functioning, which can be detrimental in terms of long-term outcomes. Therefore, it is crucial to identify evidence-based interventions which can improve the social skills of children with ADHD. The current study was an evaluation of a school-based social skills training program, called Working Together: Building Children's Social Skills Through Folk Literature. The modified version of the program with generalization enhancers was delivered in three schools to 16 children over a 10-week period. Results indicated that this program was effective for improving social skills in children with ADHD, particularly for children with poor pragmatic language skills.     

Reduced prefrontal and increased subcortical brain functioning assessed using positron emission tomography in predatory and affective murderers

There appear to be no brain imaging studies investigating which brain mechanisms subserve affective, impulsive violence versus planned, predatory violence. It was hypothesized that affectively violent offenders would have lower prefrontal activity, higher subcortical activity, and reduced prefrontal/subcortical ratios relative to controls, while predatory violent offenders would show relatively normal brain functioning. Glucose metabolism was assessed using positron emission tomography in 41 comparisons, 15 predatory murderers, and nine affective murderers in left and right hemisphere prefrontal (medial and lateral) and subcortical (amygdala, midbrain, hippocampus, and thalamus) regions. Affective murderers relative to comparisons had lower left and right prefrontal functioning, higher right hemisphere subcortical functioning, and lower right hemisphere prefrontal/subcortical ratios. In contrast, predatory murderers had prefrontal functioning that was more equivalent to comparisons, while also having excessively high right subcortical activity. Results support the hypothesis that emotional, unplanned impulsive murderers are less able to regulate and control aggressive impulses generated from subcortical structures due to deficient prefrontal regulation. It is hypothesized that excessive subcortical activity predisposes to aggressive behaviour, but that while predatory murderers have sufficiently good prefrontal functioning to regulate these aggressive impulses, the affective murderers lack such prefrontal control over emotion regulation. © 1998 John Wiley & Sons, Ltd.     

Evaluating the performance of departments of psychotherapy

Conceptual and practical issues which surround attempts at assessing the efficiency of psychotherapy departments are surveyed and the advantages and disadvantages associated with performance indicators reviewed. The issues of assessing efficiency in general and the selection of appropriate indicators at both national and local levels are discussed. It is concluded that it is possible to find indicators which reflect the value of a psychotherapeutic service to the community within which it is based, and that the identification of a generally agreed set of such parameters is a matter of priority.